Novalung - Ecmo - to Go / Ecmo

Novalung - Ecmo - "to Go" / Ecmo "light" oxygenates great -less filling


Novalung first for FAI

Thomas Buchsein of fixed-wing a air ambulance provider Flight Ambulance International (FAI) reports on the company´s first use of Novalung technology.

The letters ARC´S (acute respirattory distress syndrome) and All (acute lung injury y) stare for the most severe types of respiratory failure e, which are a common clinical appearance and thhe often lethal common path of a variety of diag gnoses such as pneumonia (including all types of influenza associated chest infections), severe multiple e trauma arc septic shock. Striving always to be att the frontier of mobile intensive care medicine, FFAI used the Novalung iLA (interventional lung as ssist) Membrane Ventilator for the first time, a new w extracorporal ´artificial lung´ technology, to assis st conventional mechanical ventilation in ARDS ppatients arc to prevent the often irreversible lung ttissue damage that is typically associated with aggress sive mechanical ventilation strategies. The system m is characterized by a low-resistance membrane, whicch is integrated in an artificial arterio -venous byp pass. Driven by the patient´s own blood pressure (thu us independent of any mechanical pump and pow wer source), the blood flow is shunted from thee cannulised femoral artery to the also-can nulise eo femoral vein through a small (´•. 4x; 4 cm) plas stic box, containing the core of the system: the af orementioned sophisticated gas-exchanging, he eparin-coated hollow-fibro diffusion membrane, w which does what the patients lungs fail to do -removin ng carbon dioxide and adding oxygen to the blood.

Our first mission with the new sysstem took us to Kuwait, where we had been aske ed not only to transport a patient. but also to as ssist the local medical team with a ven/ challen ging intensive care and mechanical ventilation. T The patient was a 52-year old technical engineer with AARDS subsequent 10 severe bilateral p neumonia and sepsis. From our preflight assessm ment, we were already aware that chest X-rays sshowed a ´white lung´ and that the ventilator was a already set to a very high oxygen concentration o of 90 per cent and a PEEP (peak end-expiratory presssure) of ! 5 mmHg, parameters that wouid normallly dearly forbid any air transport.

The FAI medical team (Dr Gotz L Leonhard, deputy chief medical officer, and Simon n Obier chief paramedic) was for this particularr mission supplemented by Bemd Resio, a very h helpful Novalung Medical Technician and ´rained in ntensive care unit nurse. After the usual general p patient assessment. Dr Leonhard performed a Dopple er-ultrasound examination, relocate and measure sanguine vessels before successfully cannulising thhem. He then connected the iLA-membrane box aand opened the arterio-venous shunt through the iLA-box in which gases and blood are separated only by the aforem mentioned low-resistance diffusion membrane, anaalogous to the natural lung. During the following g hours, it -was possible to gradually adjust the re spirator towards lung protective parameters without the e limitations usually imposed by the need for pulm monary gas exchange. Twenty -four hours lat ter, the patient was considered stable enough to ttake him onboard. The flight was conducted at the s standard cabin pressure of 7,5)00 ft without any a adverse effects - pulsoxymetry, capnometry and b blood gases remained stable throughout the flight.

Summary

The Novalung Membrane Ventilator is a lightweight, low-cost, easy-to-use pumpleess (driven by the patients cardiac output) pulmona ary assist device, clinically already well establishe ed in patients with acute lung failure. \~ is now enterring the world of aero medical transport as a new w and promising asset in helping our patients to survive.

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